肾上腺素联合替罗非班及尼可地尔冠脉注射在STEMI患者PCI术中的应用

Application of epinephrine combined with tirofiban and nicordil through coronary injection in patients with ST-segment elevation myocardial infarction during percutaneous coronary intervention

目的探讨肾上腺素联合替罗非班及尼可地尔冠脉注射在急性ST段抬高心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术中的应用效果。方法前瞻性研究2020年1月至2021年1月西安国际医学中心医院收治的STEMI患者84例,按随机数表法分为观察组和对照组各42例。对照组患者术中给予替罗非班、尼可地尔冠脉注射,观察组患者在对照组基础上联合肾上腺素冠脉注射。比较两组患者术后即刻心肌梗死溶栓试验(TIMI)分级3级的患者、矫正TIMI血流帧数(cTFC),以及术前、术后4周左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白(cTnI)的变化,并比较两组患者术后3个月的不良心血管事件发生情况。结果观察组患者术后TIMI血流3级的比率为90.48%,明显高于对照组的71.43%,cTFC为(21.33±2.05)帧,明显低于对照组的(25.48±2.26)帧,差异均有统计学意义(P<0.05);术后4周时,观察组患者的LVEF为(57.12±4.29)%、明显高于对照组的(52.33±4.06)%,LVEDD、LVESD、血清NT-proBNP、cTnI水平分别为(46.51±4.32)mm、(30.45±3.02)mm、(301.28±51.63)pg/mL、(0.45±0.11)μg/L,明显低于对照组的(51.34±4.70)mm、(36.95±3.62)mm、(388.52±63.09)pg/mL、(0.63±0.17)μg/L,差异均有统计学意义(P<0.05);观察组患者术后3个月的不良心血管事件总发生率为4.76%,明显低于对照组的19.05%,差异有统计学意义(P<0.05)。结论肾上腺素联合替罗非班及尼可地尔冠脉注射在STEMI患者PCI术中应用可明显提高患者的心肌灌注、促进心功能恢复,临床应用效果显著。

Objective To study the application affect of epinephrine combined with tirofiban and nicordil for coronary injection in patients with acute ST-segment elevation myocardial infarction(STEMI)during percutaneous coronary intervention(PCI).Methods A prospective study was conducted on 84 STEMI patients admitted to Xi'an International Medical Center Hospital from January 2020 to January 2021.The patients were divided into an observation group and a control group by random number table method,with 42 patients in each group.The patients in the control group were given tirofiban and nicordilvia coronary injection during operation,while the patients in the observation group were combined with epinephrine on the basis of the control group.The proportion of patients with postoperative immediate thrombolysis in myocardial infarction trial(TIMI)grade 3,corrected TIMI blood frame counted(cTFC),and the changes of left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),N-terminal brain natriuretic peptide precursor(NT-proBNP),cardiac troponin(cTnI)at preoperative and postoperative 4 weeks were compared between the two groups.The incidence of adverse cardiovascular events 3 months after operation was compared between the two groups.Results The proportion of postoperative TIMI grade 3 in the observation group was 90.48%,which was significantly higher than 71.43%in the control group,and the cTFC was(21.33±2.05)frames,significantly lower than(25.48±2.26)frames in the control group(P<0.05).At 4 weeks after operation,the LVEF in the observation group was(57.12±4.29)%,which was significantly higher than(52.33±4.06)%in the control group,and the LVEDD,LVESD,serum NT-proBNP,and cTnI levels were(46.51±4.32)mm,(30.45±3.02)mm,(301.28±51.63)pg/mL,(0.45±0.11)μg/L,significantly lower than(51.34±4.70)mm,(36.95±3.62)mm,(388.52±63.09)pg/mL,(0.63±0.17)μg/L in the control group(P<0.05).The total incidence of adverse cardiovascular events at postoperative 3 months in the observation group was 4.76%,which was significantly lower than 19.05%in the control group(P<0.05).Conclusion Application of epinephrine combined with tirofiban and nicordil through coronary injection in STEMI patients after PCI can significantly improve the myocardial perfusion and promote cardiac function recovery,with significant clinical effect.